tbuckley/cabot-search huggingface dataset:
A review of diversity, equity, and inclusion (DEI) efforts by medical oncology journals.
Authors: Inas Abuali, Aparna Raj Parikh, Pamela L. Kunz
Journal: Journal of Clinical Oncology (2023)

11023 Background: In recent years, there has been a growing awareness of the ongoing structural inequities impacting all facets of academic medicine. Efforts are underway to adopt an intentional and systemic approach to meaningful incorporation of DEI in academia. Here, we review the ongoing efforts by scientific peer-reviewed journals to ensure an equitable publication process, and an inclusive and diverse participation and distribution of oncological research. Methods: Medical oncology journals with the highest impact factor were identified using the SCImago Journal Rank (SJR), a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus database. 39 Journals in the first ranking quartile (Q1) with the highest impact were identified to have an SJR &gt;2. An online review of journal websites’ content was performed between Jan 8 th – Feb 8 th , 2023, to extract the data available in the accompanying table. Results: 38.5% of journals include a DEI statement on their website. One journal has a dedicated editorial director of equity. Three journals (8%) have a specific online DEI corner highlighting related articles and initiatives. 20% of the journals publicly outlined specific DEI policies, such as formalizing the process for assessment and reporting, and identifying and inviting peer reviewers with DEI expertise. Finally, 20% of journals published limited specific metrics assessing the impact of their DEI efforts, such as data regarding the primary corresponding authors at country and region level in the last five years, and the gender diversity of their editorial boards. Conclusions: Our study highlights the limited publicly available data online regarding ongoing DEI initiatives and dedicated editorial positions in high impact medical oncology journals. It is imperative that we aim for greater intentionality and transparency about such efforts, with reporting of clear and specific impact metrics. In addition, these efforts cannot be performative and must foster a more equitable scholarly publication process, promote accountability, and assist in formulating best practices. Our analysis suggests a clear unmet need and represents a call to action. High impact oncology journals have an opportunity to set the tone for the entire oncology medical community. [Table: see text]
Incidence of central nervous system metastases (mCNS) and overall survival (OS) in patients with stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiation followed by durvalumab (Durva).
Authors: John Sharp, Songzhu Zhao, Sandip Patel, Lai Wei, Mingjia Li, Jeremy Brownstein, Meng Xu WELLIVER, Karl Haglund, Joshua David Palmer, Sasha Beyer, Raju R. Raval, Peter G. Shields, Kai He, Jacob Kaufman, Regan Michelle Memmott, Asrar Alahmadi, David Paul Carbone, Gregory Alan Otterson, Carolyn J Presley, Dwight Hall Owen
Journal: Journal of Clinical Oncology (2023)

e20605 Background: In the landmark PACIFIC trial, 6.3% of patients with unresectable stage III NSCLC receiving durva after chemoradiation developed mCNS. Data on incidence of mCNS in non-clinical trial patient populations are needed to evaluate CNS surveillance strategies. Methods: We conducted a retrospective study of patients with unresectable stage III NSCLC treated with durva following chemoradiation from 2018 to 2021 with baseline CNS imaging showing no mCNS. Patient characteristics and outcomes were assessed, including age, tumor histology, stage, mCNS incidence, and survival. OS was calculated from date of initiation of durva to death or censored at last follow-up. Results: Out of 86 patients included in our study, a total of 17 (19.8%) developed mCNS after starting durva. Development of mCNS was not associated with age, sex, histology, T or N staging or PD-L1 expression (Table 1). Three patients (3.5%) had CNS-only metastases whereas 14 (16.3%) had progression outside the CNS. The median time from baseline CNS imaging to first durva was 3.8 months (IQR 3.0 – 4.9) in the cohort. The median time from first durva to development of mCNS was 4.7 months (IQR 2.3 – 8.7). Median OS in patients with mCNS was 15.2 months (95% CI 8.6 – 25.9) compared to 36.9 months (95% CI 27.2 – NR) in patients without mCNS (p = 0.010). Conclusions: Incidence of mCNS among a cohort of patients with stage III NSCLC managed with durva after chemoradiation was 19.8% which is higher than that observed in landmark clinical trials. The OS for patients with mCNS was shorter than those without mCNS. Most mCNS occurred within 6 months of starting durva and were often accompanied by systemic progression. Further research is needed to understand optimal surveillance strategies for mCNS in this patient population. [Table: see text]
Head and neck embryonal rhabdomyosarcoma clinical outcomes determinates: A pooled database analysis.
Authors: rachaita lakra, Philip A. Haddad, Usman Zaheer, Christopher Graham
Journal: Journal of Clinical Oncology (2023)

e23537 Background: Embryonal rhabdomyosarcoma (ERS) is a soft tissue sarcoma of skeletal muscle with mesenchymal precursor cells that involve the genitourinary system or head and neck. Currently, head and neck embryonal rhabdomyosarcoma (HNERS) is considered a similar entity to other ERS subtypes by the Intergroup Rhabdomyosarcoma Study Group (IRSG), with only parameningeal disease being considered as high risk. We seek to identify other higher risk phenotypes in this population. Methods: To study the demographic, molecular and IHC characteristics, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 101 cases of HNERS. Kaplan-Meier survival curves, Cox proportional-hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS). Results: 101 patients with confirmed HNERS were identified: median age of 6.5 years, male predominance with M:F ratio of 1.7. While R0 was achieved in 44%, surgical R1 and R2 were feasible in 13% and 44% of the cases. HNERS involved the following anatomic sites: Parameningeal (49%), Skull (40%), Maxilla (39%), Nasopharynx (34%), Ears (25%), Oropharynx (17%), Nervous system (16%), Larynx (14%), Mandible (12%), Internal Jugular (7%), Orbit and Carotids (6% each), Tongue (3%), and thyroid (2%). Lymph nodes, and bone marrow were involved in 11% and 2%, respectively. Metastases occurred in 4%. The stage distribution consisted of stage I (41%), stage II (34%), stage III (19%), and stage IV (6%). Clinical groups comprised: IA(23%), IB(4%), IIA(8%), IIB(3%), IIIA(45%), IIIB(12%), and IVA(4%). Risk groups consisted of low (53%), intermediate (41%), and high (6%). The cohort’s median DFS was 240 months whereas the median OS was not reached. OS was negatively affected by parameningeal (p = 0.01), nasopharyngeal (p = 0.02), ear (p = 0.02), nerve (p = 0.0001), bone (p = 0.002), and LN (p = 0.0004) involvement. The presence of metastases was associated with worse OS (p = 0.0001). The IRSG staging system (p &lt; 0.0001), the risk groupings (p = 0.0001), and the clinical groupings (p = 0.06) correlated with OS, though the latter did not reach statistical significance. Compared to no treatment, localized therapies such as surgery and radiation therapy, and combination chemotherapy had statistically significant improvement in OS (p = 0.027). Achieving CR was associated with superior OS (p &lt; 0.0001). OS wasn't impacted by age, sex, extent of surgery, IHC, BM involvement or other head and neck anatomic site involvement. Conclusions: Embryonal Rhabdomyosarcoma of the Head and Neck is a distinct clinical subtype of ERS not fully defined by IRSG clinical groups when compared to other types of embryonal rhabdomyosarcoma. Parameningeal, nasopharyngeal, ear involvement had poor OS and should be considered as a clinical grouping. This study presents updated data from a pooled cohort of patients with HNERS.
Medical terminology and interpretation of results in plain language summaries published by oncology journals.
Authors: Michel D. Wissing, Sai A. Tanikella, Preetinder Kaur, Holly R. Tomlin, Linda J. Cornfield, Amy C. Porter, Shereen C. D'Cruz, Alissa M. Alcala, Holly Capasso-Harris, Linda Tabas
Journal: Journal of Clinical Oncology (2023)

e18653 Background: Plain language summaries (PLS) are increasingly added to published scientific manuscripts in oncology, either as an abstract or standalone manuscript, to increase transparency in medical research. We evaluated PLS published in oncology journals by publication type and institution for criteria deemed essential to adequately inform laypeople. Methods: PLS published in oncology journals in 2021 or 2022 were identified in PubMed using prespecified search terms. Two medical writers independently reviewed and scored PLS based on use of medical terminology, language level, and adequate interpretation of data (i.e., a lay reader would be able to put the data adequately in context). Scoring discrepancies were resolved by a third reviewer. Established Flesch readability statistics were compared to the reviewers’ scoring. Scoring results were evaluated between institutions (academia or pharmaceutical companies) using Fisher's exact tests in R. Results: 63 PLS were analyzed in 9 oncology journals; scoring results are displayed in the table. All PLS manuscripts were written by pharmaceutical companies; PLS abstracts were provided by both pharmaceutical companies and academia. Only 5% of all PLS were graded as understandable at the pre-university level. Flesch readability statistics provided similar results, and reviewers’ scores correlated with Flesch readability statistics (n = 38, W = 0.599, r = 66.5, P= .002). Medical terminology was avoided or explained in all PLS manuscripts and in 23% of PLS abstracts. Similarly, data were adequately interpreted in all PLS manuscripts and 17% of PLS abstracts. PLS provided by pharmaceutical companies avoided or explained medical terminology ( P&lt; 0.001 ) and adequately interpreted all data more often than PLS written in academia ( P&lt; 0.001). Importantly, 6 PLS (10%) were found to overstate results. Conclusions: PLS published in oncology journals, particularly as abstracts, frequently had inadequate data interpretation and often used language only accessible for people with advanced scientific or medical training, both when written by academic investigators or within pharmaceutical companies, limiting their intended purpose. We recommend scientists in academia and pharma to adapt easily interpretable language in PLS, which would allow PLS to be used to advance equal access to healthcare research. [Table: see text]
UCLA l-08: A phase ib/II study of combined HER inhibition adding necitumumab and trastuzumab to osimertinib in patients with refractory EGFR-mutated lung cancer.
Authors: Jonathan W. Goldman, Amy Lauren Cummings, Karo K. Arzoo, Eddie Hong-Lung Hu, Edward B. Garon, Evangelia K. Kirimis, Olga Olevsky, Brian Anthony DiCarlo, Sheldon J. Davidson, Anita Kaul, Zorawar Singh Noor, Melody A. Mendenhall, Deborah J.L. Wong, Holly K.T. Huang, Maria A Velez, James Chauv, Yosef Yarden, Dennis J. Slamon
Journal: Journal of Clinical Oncology (2023)

e21165 Background: Patients (pts) with metastatic EGFR-mutated NSCLC who have progressed on osimertinib have limited treatment options. Dual EGFR with HER2 blockade results in complete and long-term reversal of osimertinib resistance in preclinical models. Methods: This is an investigator-initiated, single arm, open label phase 1b/2 study to identify the recommended phase 2 dose (RP2D), safety, tolerability, and preliminary efficacy of the combination of osimertinib, necitumumab, and trastuzumab (ONT) in adults with histologically confirmed, metastatic NSCLC with an activating and sensitizing EGFR mutation who have progressed on osimertinib as their most recent treatment. Study pts receive daily oral osimertinib in conjunction with necitumumab and trastuzumab intravenously every other week. In phase 1b, a 3+3 dose-escalation design is used to determine the RP2D (Table 1). In phase 2, if ≥ 2 responses are seen out of 10 pts treated at the RP2D, an additional 10 pts will be accrued. Patient reported outcomes (PRO-CTCAE) and quality of life (FACT-L) data are collected prospectively. Efficacy is assessed as objective response rate (ORR) based on RECIST 1.1 criteria. Results: 22 pts (median age = 63; range = 40-82) have been enrolled and treated. The most commonly observed treatment-related AEs seen at any DL included acneiform rash (63.6%), headache (45.5%), nausea (40.9%), dry skin (36.4%), diarrhea (31.8%), paronychia (27.3%), oral mucositis (27.3%), vomiting (22.7%), fatigue (18.2%), chills (18.2%), and anorexia (18.2%). Grade 3 treatment-related toxicities were acneiform rash (22.7%), diarrhea (4.5%), decreased lymphocyte count (4.5%) and hypertension (4.5%). There were no treatment-related Grade ≥ 4 AEs. 12 evaluable pts were enrolled in phase 1b [3 at Dose Level (DL) 1, 3 at DL 2, and 6 at DL 3]; 3 non-evaluable pts were replaced. Pts treated at DL 1 and DL 2 had no dose-limiting toxicities (DLTs) and 1/6 pts at DL 3 had a DLT (persistent grade 3 rash). Due to grade 2 and 3 rash and paronychiae occurring after cycle 1 at DL 3, DL2 was determined to be the RP2D.The proportion of evaluable phase 1b pts achieving partial response or stable disease was 58.3% (7/12). Seven pts have been enrolled at DL2. Conclusions: ONT toxicities are manageable, and the combination has promising preliminary efficacy in refractory EGFR-mutated metastatic NSCLC. Evaluation of phase 2, stage 1 is expected to be completed by April 2023 and will be reported at the meeting. Clinical trial information: NCT04285671 . [Table: see text]
A pilot curriculum to transition from 2D to 3D image-guided brachytherapy: A preliminary needs assessment.
Authors: Joy Ogunmuyiwa, Usman Malami Aliyu, Adedayo Joseph, Bolanle Comfort Adegboyega, Onyinye Balogun
Journal: Journal of Clinical Oncology (2023)

11039 Background: Gynecologic cancers are one of the leading causes of death globally with a disproportionate burden of disease found in low to middle income countries (LMIC). Brachytherapy is often a necessary component in treatment management as it can deliver a high dose of radiation to the tumor while employing a steep dose fall off that spares the adjacent organs at risk. With 3D image guided brachytherapy (3D-IGBT), treatment planning utilizes volumetric images with the target volume and organs at risk contoured, reducing toxicity and improving outcomes when compared to 2D planar imaging. Despite this advantage, only a limited number of LMIC centers perform 3D-IGBT. Transitioning to 3D-IGBT requires considerable planning, resources, and training. The development of a multidisciplinary, computer-based training program to facilitate the transition to 3D-IGBT was identified as a priority of multiple Radiation Oncology departments in Nigeria. The aim of this preliminary needs assessment was to identify the necessary resources and anticipated barriers to development of a pilot training curriculum for the transition to 3D-IGBT. Methods: An anonymous, 16-question online survey was distributed to clinicians, physicists, radiation therapists, and staff within a Radiation Oncology department of a teaching hospital in Lagos, Nigeria. Results: In January 2023, 53 respondents completed the survey. Of the respondents, 36.5% were female and 63.5% were male. The average age was 37.5 (SD = 7.8). Clinical experience ranged from &lt; 5 years (52.6%), 6-10 years (9.4%), to &gt; 10 years (30.2%). Respondents included radiation therapists (28.8%), clinicians (27%), nurses (23.1%), and physicists (15.4%). Multiple barriers to implementation of 3D-IGBT were identified including lack of training (79.2%) or experience (58.5%), lack of financial investment (50.9%), and anticipated repair/replacement of equipment (41.5%). A majority of respondents identified staff training/education (66%) as critical to delivering 3D-IGBT. When asked about the curriculum components needed, most respondents believed that it should include plan review (96.2%), contour review (94.3%), and peer review of clinical cases (92.5%). Conclusions: Various areas of potential need were identified through this preliminary needs assessment, most notably, staff training. These findings suggest that there is an unmet need to further develop and implement a structured didactic and skills-based curriculum to transition from 2D to 3D-IGBT at these institutions. Identified focus areas including contour, peer, and plan review will help guide the refinement of this curriculum. These findings are an important first step in delivery of safe and efficacious 3D-IGBT in an LMIC.
Uncertainty and coping in patients with newly diagnosed indolent non-Hodgkin’s lymphoma (iNHL).
Authors: Richard Newcomb, Patrick Connor Johnson, Daniel Yang, Hermioni L. Amonoo, Tejaswini More Dhawale, Yi-Bin Albert Chen, Areej El-Jawahri
Journal: Journal of Clinical Oncology (2023)

7568 Background: iNHLs are a heterogenous group of incurable diseases with prolonged illness courses requiring intermittent periods of surveillance and treatment. Due to illness uncertainty, patients with iNHL struggle with immense psychological distress. Yet, studies exploring coping, prognostic uncertainty and distress in this population are limited. Methods: We conducted a cross sectional study of adults (age ≥ 18) newly diagnosed with iNHL at a single academic center. We enrolled consecutive patients who were diagnosed ≤ 3 months prior to study enrollment. At baseline, we collected patient reported outcomes to assess QOL (Functional Assessment of Cancer Therapy), psychological symptoms (Hospital Anxiety and Depression Scale), prognostic understanding (Prognostic Awareness Impact Scale), and coping (Brief COPE). We categorized coping as approach-oriented (active coping, use of emotional support, positive reframing, acceptance) and avoidant (behavioral disengagement, denial, and self-blame). We used median split to differentiate between low and high utilizers of approach or avoidant coping. Results: We enrolled 70.6% (48/68) of eligible patients newly diagnosed with iNHL (mean age 66.8 yrs; 39.6% chronic lymphocytic leukemia/ lymphoma; 33.3% follicular lymphoma). At baseline, nearly one-third (31.2%) experience clinically significant symptoms of anxiety and depression. 45.8% of patients identified prognostic uncertainty as the “the most stressful part of being a patient,” and 31.2% reported having “difficulty letting go of thoughts about their prognosis.” Notably, patients had significant misperceptions about their prognosis with incurable iNHL, as 47.9% reporting that a cure was at least ‘somewhat’ likely. Patients with iNHL most often used acceptance (56.3%), denial (47.9%), and emotional support (47.9%) as coping strategies. Patients who were high utilizers of multiple approach-oriented coping strategies experienced fewer anxiety (B = -2.66, p = 0.01) and depression (B = -1.73, p = 0.02) symptoms and improved QOL (B = 9.43, p = 0.001). Patients who highly utilized any avoidant-oriented coping strategies experienced increased anxiety symptoms (B = 2.16, p = 0.05), but no difference in depression symptoms or QOL. Conclusions: Patients with iNHL report immense prognostic uncertainty and psychological distress. Use of multiple approach oriented coping strategies was associated with decreased psychological distress and improved QOL. Interventions to address prognostic uncertainty and to promote approach oriented coping in patients with iNHL are sorely needed and have the potential to ameliorate psychological distress and improve QOL in this vulnerable population.
Effect on hospital outcomes of hematopoietic stem cell transplant recipients with <i>Clostridium difficile</i> infection.
Authors: Armaan Dhaliwal, Aalam Sohal, Hunza Chaudhry, Kanwal Bains, Ishandeep Singh, Shivam Kalra, Dino Dukovic, Jay Patel, Ponnandai Sadasivan Somasundar
Journal: Journal of Clinical Oncology (2023)

e20003 Background: Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of Clostidium difficile infection (CDI) due to use of cytotoxic chemotherapy, broad-spectrum antibiotics, and sustained neutropenia. Because of the immunocompromised nature of these patients, the prevalence rates of CDI in HSCT recipients are high. In this study we evaluate the impact of CDI on in-hospital outcomes. Methods: We included all patients with a prior diagnosis or a procedure code for HSCT using ICD-10 codes from National Inpatient Sample. We excluded patients admitted for less than 14 days to exclude admissions for elective chemotherapy or catheter placement. Patients were stratified into two groups based on the presence of CDI. Information was collected regarding patient demographics, Charlson comorbidities, underlying hematologic disease, resource utilization (LOS and total hospitalization charges), and outcomes. The outcomes included sepsis, shock, acute kidney injury, ICU admission, and in-hospital mortality. The association between CDI and outcomes was studied using multivariate analysis. Results: 62,415 patients were included in the study. Of them, 5,275 (8.5%) patients developed CDI. The majority of the patients with CDI were White (70.4%), men (57.1%), and aged between 45-64 years (52.5%). Patients with CDI had a higher incidence of sepsis (21.1% vs. 16.5%), shock (8.1% vs. 5.8%), AKI (23.8% vs. 19.4%), ICU admission (9.6% vs. 7.6%) and in-hospital mortality (5.8% vs. 4%). After adjusting for confounding factors, CDI was associated with a 32% higher odds of in-hospital mortality (aOR-1.32, 95% CI-1.01-1.74, p-0.046). CDI was also associated with 26% higher odds of developing shock (aOR-1.26, 95% CI-1.01-1.72, p-0.013) and 27% higher odds of developing AKI (aOR-1.27, 95% CI-1.09-1.49,p-0.002). No statistically significant difference was noted in the risk of ICU admission between the two groups. Patients with CDI had a longer length of stay (29.5 days vs. 24.8 days, p &lt; 0.001) and higher hospitalization charges ($400,017 vs. $508,090, p &lt; 0.001). Conclusions: Our study suggested a relationship between CDI and worse outcomes in HSCT recipients. Physicians should be aware of this association and promptly recognize and initiate treatment in these patients to improve outcomes. [Table: see text]